For most people, few things are more innocuous than a glass of milk. But for some people with sinusitis, this staple of Americana can have a big impact.

We’ll examine how milk and other elements of your diet can affect your sinus symptoms. We’ll also explore problems at your workplace that can lead to headaches and nasal blockage, including the phenomenon known as sick building syndrome.

Milk and Wheat

Although food allergies that trigger sinusitis are relatively rare, they do occur often enough that I’m always on the lookout for them in people whose symptoms cannot be explained by more common causes. The tip-off that such an allergy may be present is when postnasal drip is the primary symptom.

If you are particularly bothered by such drainage or constant collection of phlegm in the back of the throat, especially upon awakening you may well have a food allergy and not even be aware of it.

What causes food allergies is not well understood, but it’s clear that when certain people eat specific foods, undesirable reactions occur. In some cases, such as allergies to shellfish or peanuts, these effects can be immediate, resulting in hives or swelling of the face or throat.

In severe cases, these allergic reactions can be lifethreatening. In most cases, however, the effects are more subtle. Symptoms have a gradual onset and are less marked, to the point where people often do not make the connection between the food and the subsequent reaction it causes.

Milk and wheat are the two foods that most commonly cause the allergic reaction that leads to excess mucus production and troublesome postnasal drip. This drainage can also block the nose, impairing breathing and blocking the sinus ostia, prompting an infection.

Diagnosing food allergies can be a bit tricky, as there is no standardized approach used by all allergists and test results can be unreliable. Some favor skin testing similar to that used to detect pollen and dust allergies; minute amounts of the food are placed just beneath the skin to see if any reaction occurs.

Others use a blood test called RAST to look for antibodies to food proteins in the blood. The best way to determine if you have such an allergy is an elimination diet; in other words, you stop eating the suspect food for a period of time and see if that makes a difference.

I recommend a trial of at least two weeks, and four weeks is ideal if you can hold out that long, then you’ll know with some certainty whether you’re really allergic. During the trial, you have to be very strict in your diet. With milk, you need to cut out not just the milk you drink, but all products containing even small quantities of milk.

That includes cheese, yogurt, and many baked goods. You’d be surprised at how many products contain small amounts of milk, including many breads, sauces, and salad dressings. You’ll have to check labels to be sure products are milk-free.

One final milk note. It’s the protein component in the milk, not the fat, that causes the increase in mucus production. So simply switching to nonfat milk, while perhaps good for your heart and waistline, won’t affect mucus production.

With wheat and wheat-based products, such as bread and pasta, the source of the problem is also a protein in this case, one called gluten. Again, eliminating wheat for two to four weeks should reveal whether you have this allergy.

People with sinus problems who truly are allergic to milk or wheat often see dramatic symptom improvement when they eliminate the offending food.

Many patients whose postnasal drip did not improve with conventional medications (including antihistamines, steroid sprays, and antibiotics) have reported a huge decrease in the amount of mucus produced by their nose within a few weeks of starting an elimination diet.

Alcohol

It’s not uncommon for people with sinusitis to develop a new infection or see their symptoms flare up within twenty-four hours of drinking an alcoholic beverage. The problem is not the alcohol itself but the presence of impurities known as congeners, which are the by-products of the fermentation and aging process.

Congeners provide much of the beverage’s taste and aroma, but some have histamine-like properties. Similar to what happens with an allergic reaction to pollen or dust, individuals who are sensitive to these impurities can experience nasal congestion, drainage, and headaches.

You may have this alcohol sensitivity without knowing it. If you suspect you might, you can usually sidestep this problem by avoiding alcoholic beverages likely to contain high amounts of congeners.

If you like wine, you’re better off with white wines, especially those processed in stainless steel containers, instead of red wines, which are aged in wooden barrels and contain many more by-products.

If you drink liquor, you’ll have fewer problems with clear varieties, such as vodka (especially brands that are “smoother” and have been highly distilled), than with darker, aged liquors, like bourbon and scotch.

The amount of congeners in beer varies, but in general, lighter colored beers have fewer than darker ones. And if you heed these instructions, the next morning you may notice a bonus benefit along with reduced sinus symptoms it’s actually the congeners, as much as the alcohol, that are believed to be the cause of a hangover.

Smoking

In addition to damaging your lungs, cigarette smoking impairs the function of the tiny hairs (cilia) in your nasal passages and sinuses that sweep out mucus and debris. When cilia don’t function well, mucus and bacteria build up in the sinuses, leading to infections.

If you smoke, quitting is probably the single most important step you can take to improve your sinus symptoms. Cilia are resilient, so after you quit smoking, their normal function returns, which often leads to fewer sinus infections.

Workplace

The incidence of sinusitis and asthma has increased during the past decade. Although the cause for this increase remains unknown, one theory is that it’s because more people are working in sealed buildings where they can’t open a window to let in fresh air.

Instead, the interior air is constantly recirculated. As a result, it tends to be quite dry. And if the building is contaminated with indoor pollutants such as mold and spores, fibers from carpeting and upholstery, and chemicals in insulation and copy machines then the ventilation system serves to recirculate the impurities.

Tainted air can irritate the lining of your nose, lungs, and sinuses, blocking breathing and setting the stage for an infection. This reaction can be due to a true allergic response in which your body’s immune system triggers the release of a host of inflammatory factors.

It can also result from direct inflammation in which a chemical, for example, burns or irritates the nasal mucosa. This phenomenon of contaminated workplaces is known as sick building syndrome. Its existence at a given site can be difficult to define and measure, but it’s something to consider if any of the following are true:

Your nasal and sinus symptoms are worse at work.

Coworkers who sit near you come down with similar symptoms.

You work in a particularly old building with poor ventilation.

If you suspect there’s a problem, talk to your supervisor or building manager about what can be done to improve air quality. You can also contact the local representative of the Environmental Protection Agency. A link on the agency’s website (epa.gov) includes helpful background and contact information.

Some of my patients who were convinced their repeated sinus infections were the result of workplace pollutants received dramatic improvement by simply moving their desks to a different location (such as away from an overhead vent). In other cases, a portable air filter at the desk provided relief.

In the most severe cases, the only solution may be moving to a different building or finding a new job. I recognize it’s a lot easier said than done, but sometimes radical changes in lifestyle and workplace may be called for when recurrent sinus infections are seriously affecting the quality of your life.

Fragrance Factor

Strong perfumes and colognes are another potential workplace hazard for people with sinusitis, especially in offices where everyone is crammed side by side into small cubicles. Such unintended sharing of personal air space can cause what might be called sick cubicle syndrome.

If you have a particular sensitivity to strong fragrances, you might experience an eruption of nasal and sinus symptoms, including itchy eyes and nose, runny nose, and congestion, all of which can lead to a full-blown case of sinusitis.

Raising this issue without offending your coworker can be a touchy matter. But if you’re tactful, you should find that the benefits to your health outweigh the temporary social discomfort.

You might also discuss the problem with your boss if implementing an across-the-board policy seems like an easier path than taking it up with the pungent coworker.